18F-FDG PET/CT对无恶性肿瘤炎症性肌病患者肌肉疾病活动性的评估价值

Value of 18F-FDG PET/CT in assessing muscle disease activity in inflammatory myopathies

    摘要
  • 摘要:
    目的 探讨18F-氟脱氧葡萄糖（FDG） PET/CT在评估无恶性肿瘤炎症性肌病（IM）患者肌肉疾病活动性中的价值。
    方法 采用回顾性病例-对照研究，分析2015年10月至2024年8月在南京大学医学院附属鼓楼医院接受18F-FDG PET/CT检查的66例无恶性肿瘤IM患者的临床和18F-FDG PET/CT影像资料，其中男性18例、女性48例，年龄（56.9±15.4）岁。测量所有患者双侧共16块肌肉（三角肌、肱二头肌、肱三头肌、胸大肌、腰大肌、臀肌、内收肌群和股四头肌）的最大标准摄取值（SUVmax），取其平均值作为肌肉标准摄取值（SUVM），并采用肝脏SUV（SUVLIV）对其进行标准化，获得SUVM/SUVLIV。采用肌炎目的治疗指数（MITAX）量表评估患者肌肉疾病活动性，将患者分为活动组与非活动组，采用受试者工作特征（ROC）曲线分析SUVM/SUVLIV对IM患者肌肉疾病活动性的诊断效能，并采用Spearman秩相关对SUVM/SUVLIV与患者一般情况、实验室指标等进行相关性分析。不符合正态分布的计量资料的组间比较采用Mann-Whitney U检验。
    结果 66例患者中，活动组49例、非活动组17例。活动组患者的SUVM/SUVLIV为0.66（0.54, 0.95），高于非活动组患者0.48（0.34, 0.52），且差异有统计学意义（Z=3.952，P<0.001）。ROC曲线分析结果显示，SUVM/SUVLIV区分活动组与非活动组患者的最佳临界值为0.57，灵敏度为65.3%，特异度为94.1%，曲线下面积为0.824（95%CI：0.710~0.906）。相关性分析结果显示，SUVM/SUVLIV与患者的MITAX量表评分（r=0.595，P<0.001）、肌酸激酶（r=0.590，P<0.001）、肌酸激酶同工酶（r=0.420，P<0.001）、铁蛋白（r=0.558，P<0.001）及C反应蛋白（r=0.355，P=0.005）均具有相关性，而与患者的疾病分型（r=0.073，P=0.559）无相关性。
    结论 18F-FDG PET/CT半定量指标SUVM/SUVLIV可以有效评估无恶性肿瘤IM患者的肌肉疾病活动性。

     

    Abstract:
    Objective To investigate whether 18F-FDG PET/CT can effectively assess muscle disease activity in inflammatory myopathy (IM) without malignant tumors.
    Methods The clinical data and 18F-FDG PET/CT imaging data from 66 IM patients without malignant tumors were retrospectively collected. The maximum standardized uptake value (SUVmax) of a total of 16 bilateral muscles (deltoid, biceps brachii, triceps brachii, pectoralis major, psoas major, gluteal muscles, adductor group, and quadriceps) was measured in all patients. The mean value of these measurements was calculated as the muscle standardized uptake value (SUVM), which was then normalized using the liver SUV (SUVLIV) to obtain SUVM/SUVLIV. The Myositis Intention to Treat Activity Index (MITAX) was used to evaluate muscle disease activity, and patients were divided into active and inactive groups for intergroup comparison. The diagnostic performance of SUVM/SUVLIV in assessing disease activity in IM patients was analyzed using receiver operating characteristic (ROC) curve analysis. Spearman’s rank correlation was used to analyze the correlations between SUVM/SUVLIV and patients’ general characteristics, laboratory parameters, and other relevant variables.
    Results The SUVM/SUVLIV in active patients was 0.66 (0.54, 0.95), significantly higher than that in inactive patients 0.48 (0.34, 0.52), with statistical significance (Z=3.952, P<0.001). ROC curve analysis showed that the optimal SUVM/SUVLIV cutoff value for distinguishing active from inactive groups was 0.57, with a sensitivity of 65.3%, specificity of 94.1%, and an area under the curve (AUC) of 0.824. Correlation analysis revealed that SUVM/SUVLIV was significantly associated with MITAX score (r=0.595, P<0.001), CK (r=0.590, P<0.001), CK-MB (r=0.420, P<0.001), ferritin (r=0.558, P<0.001), and CRP (r=0.355, P=0.005), but not significantly correlated with disease subtype (r=0.073, P=0.559).
    Conclusion The semi-quantitative parameter SUVM/SUVLIV derived from 18F-FDG PET/CT holds potential value in the diagnosis and management of IM patients without malignant tumors. SUVM/SUVLIV can effectively assess muscle disease activity in IM patients without malignant tumors.

     

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